Auto Case Assignment

What is Case Assignment?

Case Assignment is the process of linking a provider to a patient case. Once assigned, the provider gains access to the patient’s case details and can proceed with next steps such as reviewing information, adding notes, or prescribing treatment.

What is Auto Case Assignment?

Auto Case Assignment is an automated mechanism designed to distribute incoming cases among available providers intelligently and efficiently.
Instead of manually assigning each case, the system uses a set of predefined rules, conditions, and prioritization logic to automatically determine which provider should handle a new case.

This ensures:

• Faster response time for patients
• Even workload distribution among providers
• Reduced manual intervention and errors

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Objectives

The primary goals of Auto Case Assignment are:

1. Automation: Eliminate the need for manual case assignment.
2. Efficiency: Assign cases in real time as soon as they are created or updated.
3. Fairness: Maintain balanced workload distribution across all eligible providers.
4. Accuracy: Ensure cases are assigned only to providers who meet eligibility criteria.
5. Scalability: Support a growing number of providers and cases without performance issues.

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Core Components

Auto Case Assignment involves several components working together:

Component	Description
Trigger Event	Defines when the assignment should happen (e.g., on case creation, status change, or specific workflow step).
Eligibility Rules	Conditions that determine which providers qualify for assignment (e.g., language, location, capacity, BMI rules, active status).
Assignment Logic	The algorithm that picks the most suitable provider from the eligible list (e.g., least load).
Assignment Record	Stores the outcome of the auto-assignment (e.g., assigned provider ID, timestamp, case is auto assigned flag).
Override Handling	Logic to handle cases where auto-assignment should be skipped or manually overridden (e.g., Sync States).

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Key Conditions & Rules

Below are typical conditions and filters applied before assigning a case automatically:

Rule	Description
Provider Active Status	Only active providers can be considered.
Provider Availability	Provider must not be currently overloaded or marked unavailable.
Specialization Match	Provider’s specialization should match the case type or diagnosis.
Maximum Load Check	Ensures provider hasn’t exceeded the maximum allowed concurrent cases.

⚙️ All rules and conditions are configurable through system.

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Assignment Flow

Here’s a high-level flow of how auto-assignment works:

1. Case Created → A trigger event occurs.
2. Eligibility Filtering → System filters out non-eligible providers.
3. Load Evaluation → Among eligible providers, system evaluates workload or ranking using Global and Org Daily limit.
4. Provider Selection → The best-suited provider is chosen using the assignment algorithm.
5. Case Assignment → Case is assigned, and assignment details are recorded in the database.
6. Notification → Provider receives a notification (email, SMS).

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Technical Implementation

The Auto Case Assignment feature is primarily implemented at the backend service layer and interacts with multiple modules such as Case Management, Organization Setting, Provider Management, and Notification Systems.

1. Trigger Points

Auto-assignment is initiated automatically from specific trigger points in the application:

• On Case Creation - When a new case is created, the system immediately attempts to assign it.

Each trigger calls the Assign Case method (or equivalent service handler), which handles the complete assignment workflow.

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2. Rule Evaluation Layer

The Rule Evaluation Layer is the heart of the Auto Case Assignment process.
It determines whether automatic assignment should proceed and identifies which providers are eligible to receive the case.

Each provider must satisfy a set of eligibility rules derived from organization settings, patient information, and global configurations.
These rules are modular, reusable, and can be easily extended as new business requirements arise.

Evaluation Process

The rule evaluation follows a structured sequence of checks:

1. Auto-Assignment Configuration Check
   The system first verifies whether the organization has auto-assignment enabled.
   If the setting is disabled, the process stops immediately and no assignment occurs.

2. Physician Eligibility Setup
   The organization must define a list of physicians eligible for auto-assignment.
   If this list is missing or empty, the process is skipped to prevent unintended assignments.

3. Visit Type Validation
   Only asynchronous visit types are eligible for automatic assignment.
   If the case involves a synchronous visit type auto-assignment is not performed.

4. Respondent State Detection
   The patient’s state is extracted either from their user profile or from form responses.

5. State Eligibility Verification
   Each state has specific configuration settings that determine whether asynchronous assignments are permitted.
   If the state is not marked as eligible for async visits, the case is excluded from auto-assignment.

6. Physician Availability by State
   From the pre-configured list of assignable physicians, the system filters out only those authorized to operate in the patient’s state.
   If no physicians are available for that region, the process logs the event and stops gracefully.

7. Patient Data Extraction
   The system extracts relevant patient information such as age, date of birth, BMI, weight, and address from their responses.
   This structured data helps determine the best-suited physician based on patient demographics or medical requirements.

8. Preference and Health Metric Mapping
   The extracted patient data is transformed into a preference object that includes computed attributes such as age, BMI, and language preferences.
   This object represents the patient’s key characteristics relevant to case assignment.

   The system then cross-references these patient preferences with each physician’s predefined preference criteria, which are configured at the organization level.
   These criteria typically include parameters such as:

   • BMI Range — Minimum and maximum BMI values a physician is eligible to handle
   • Age Range — Minimum and maximum patient age suitable for the physician’s specialization
   • Language Compatibility — Physician must support at least one of the patient’s preferred languages

9. Physician Capacity Validation
   Before final assignment, the system checks each physician’s current workload and maximum capacity settings Only physicians below their capacity limit are considered available for assignment.

   • Organization Daily Cases Limit
   • Global Daily Cases Limit

10. Best-Match Selection
    Once all filters and rules are applied, the system invokes the matching logic to select the most suitable physician.
    The selection is based on organizational strategy (e.g., least load).
    If no matching physician is found, the system logs the case as “unassigned.”

3. Notification Integration

After successful assignment:

• The provider is notified via email, or SMS.
• The patient record is updated with the assigned provider’s info.
• Add Case Assign webhook can notify external systems(For Configured Url in systems).

System Configuration Reference

Auto Case Assignment behavior is controlled through a combination of Organization Settings, Global Settings, and Physician Preferences. This section explains where each configuration resides, when it is applied during the process, and how it affects the rule evaluation flow.

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1. Global-Level Settings

These define system-wide parameters applicable across all organizations.

Setting Name	Purpose	When It's Used
stateList	Contains configuration for each U.S. state, including async eligibility.	Step 5 – State Eligibility Verification

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2. Physician-Level Preferences

Each physician can have predefined preference configurations that determine their eligibility for certain patient profiles.

Configuration Locations

Physician preferences are distributed across two locations in the admin interface:

1. TPA User Management

   • Navigate to: TPA Roles → Select User
   • If the selected user has a TPA medical role, available state selection will be displayed
   • Configure which states the provider is licensed to operate in

2. Organization Settings - Auto Assign Configuration

   • Navigate to: Organization Settings → Company Setup Tab → Auto Assign Settings
   • Enable auto assignment to reveal additional configuration options
   • Step 1: Select physicians eligible for auto assignment (add or remove providers from the list)
   • Step 2: Click on a physician to open the detailed configuration popup with the following fields:
     • Patient BMI Threshold (Min/Max range)
     • Patient Minimum Age Preference
     • Patient Maximum Age Preference
     • Organization Daily Cases Limit
     • Select Language Preference
     • Total Global Daily Cases Limit

Preference Parameters

Preference	Description	When It's Evaluated
BMI Range	Defines acceptable BMI range of patients physician can be assigned.	Step 8 – Preference and Health Metric Mapping
Age Range	Defines acceptable patient age range.	Step 8 – Preference and Health Metric Mapping
Languages	Specifies languages physician can communicate in.	Step 8 – Preference and Health Metric Mapping
Active State List	Defines states in which physician is licensed to operate.	Step 6 – Physician Availability by State
Organization Daily Cases Limit	Maximum cases per day for the physician within the organization.	Step 9 – Physician Capacity Validation
Global Daily Cases Limit	Maximum cases per day for the physician across all organizations.	Step 9 – Physician Capacity Validation

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3. Organization-Level Settings

These configurations are specific to each organization and determine how auto-assignment behaves for that entity.

Preference	Purpose	When It's Used
Auto Assign Case	Enables or disables auto case assignment for the organization.	Step 1 – Auto-Assignment Configuration Check
Auto Assign Physicians	List of physicians eligible for auto-assignment.	Step 2 – Physician Eligibility Setup
Organization Languages	Defines supported languages for patients and physicians.	Step 8 – Preference and Health Metric Mapping

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Getting Help

Contact CareGLP support for guidance and the most up-to-date information.